Term
| If the pt exhibits s/s of difficulty paying attention, are easily distracted & disoriented, have illusions, misinterpretations or hallucinations then nurse knows these are signs of __________________ . |
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Definition
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Term
| If the pt has primarily memory impairment, deterioration of language function, impaired ability to execute motor functions, inability to recognize or name objects, inability to think abstractly, plan, initiate, sequence, monitor or stop complex behaviors .... the nurse knows these are signs of __________. |
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Definition
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Term
| If the patient is avoidant of social activities, doesn't really want to leave the house, doesn't perform his ADLs, and appears sad/upset a lot, the nurse knows these are signs of .... |
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Definition
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Term
| What are some causes of Dementia? Which one is reversible dementia? |
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Definition
| Alzheimer's Disease, Vascular Disease, Pick's Disease, HIV, Parkinson's Disease, Huntington's Disease & Creutzfeldt-Jakob Disease (<-- is reversible dementia) |
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Term
| What is the nursing process for a pt diagnosed with Alzheimer's Disease? |
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Definition
| provide close supervision for ADL's (but prompt them to do these things on their own). Speak to an Alzheimer's pt in calm tones when interacting, allow the client enough time to respond and comprehend and use verbal clues if needed. Supportive touch can be used if needed. Try to keep noise to a minimum. Monitor their responses to visitors, monitor sleep & elimination patterns. Also monitor food and fluids (fix foods they desire), discourage daytime napping. Encourage exercise. |
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Term
| What is the nursing process for a pt diagnosed with Dementia? |
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Definition
| provide close supervision for ADL's, manage confusion by speaking in calm tones, allow the client to respond and comprehend and use verbal cues if needed, supportive touch can be used if needed, keep noise to a minimum, monitor responses to visitors, monitor sleep and elimination patterns as well as food and fluids, discourage daytime napping & encourage exercise. |
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Term
| Is the nursing process for delirium very similar to that of Alzheimer's? |
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Definition
| Yes, almost exactly the same. |
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Term
| List specific helpful behavioral and communication techniques for the patient with Alzheimer's. |
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Definition
| Supportive Touch, (calm tones that convey caring is helpful when words are not understood) and Reminiscence Therapy is helpful (this is thinking about or relating personally significant past experiences. |
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Term
| What are the safety concerns of a pt with dementia? |
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Definition
| teach client to request assistance for activities but offer unobtrusive assistance, provide close supervision for activities, promptly responds when the pt calls, avoid situation that would cause the patient to become agitated or angry. Having a daily routine is huge in preventing this from happening. |
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Term
| List safety concerns for a Delirium patient? |
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Definition
| teach client to request help with activities, provide close supervision for activities, promptly respond when patient calls. |
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Term
| cognitive disorders are a group of conditions characterized by the disruption of thinking, memory, processing, and problem solving. true or false? |
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Definition
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Term
| delirium & dementia are examples of _________ disorders. |
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Definition
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Term
| What are some differences with s/s of delirium (as to dementia?? |
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Definition
| delirium's impairments fluctuate & change through the day (Alzheimer's is more stable),increased confusion at night or sundowning (Alzheimers remains stable), Personality change is rapid with Delirium (it is gradual with Alzheimers), Delirium can have hallucinations & illusions (Alheimers usually does not), VS can be unstable + abnormal d/t delirium (VS are usually stable with alzheimers) |
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Term
| Delirium is usually caused as secondary to another disease or medical condition such as infection, or substance abuse OR is it generally caused by a chronic disease? |
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Definition
| Delirium is usually secondary to another disease or medical condition such as infection or substance abuse (Alzheimer is d/t chronic disease, chronic alcohol abuse or permanent trauma like a head injury) |
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Term
| Which is reversible, delirium or Alzheimers? |
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Definition
| delirium is reversible. dementia is irreversible & progressive. |
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Term
| Why does the dementia in Alzheimers occur? |
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Definition
| it is progressive deterioration in function d/t neurotransmitter deficiency, the most prevalent form of dementia and is characterized by memory loss, deficits in thought process, and behavioral changes in 4 stages. |
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Term
| What are helpful interventions for a family whose member has DELIRIUM? |
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Definition
| promote safety, manage confusion in calm tones, promote sleep and proper nutrition |
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Term
| What are helpful interventions for a family whose member has DEMENTIA? |
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Definition
| promote safety, promote adequate sleep & proper nutrition, hygiene and activity, structure a routine, provide emotional support, promote interaction and involvement |
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Term
| WHat is "Inability to recognize a name objects despite intact sensory abilities"? |
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Definition
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|
Term
| What is the deterioration of language function called? |
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Definition
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|
Term
| What are the medications given to Delirium patients? |
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Definition
| Haldol, sedatives, and benzodiazepines |
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Term
| Aricept & Namenda are meds to treat: |
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Definition
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Term
| _____________ is when the client makes up tories when questioned about events or activities that she does not remember. This may seem like lying, but it is actually an unconscious attempt to save self-esteem and prevent admitting that they do not remember the occasion. |
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Definition
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Term
| __________ is when both the client and family member refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others. |
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Definition
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Term
| __________ is impaired ability to execute motor functions despite intact motor abilities. |
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Definition
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|
Term
| Alzheimer's patients experience progressive ___________ in the later stage. |
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Definition
| Aphasia (deterioration of language) |
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|
Term
| What are the 4 stages of Alzheimers? |
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Definition
| Stage 1 is Forgetfulness (short term memory loss, decreased attn span, subtle personality changes, mild cognitive deficits) stage 2 is confusion (obvious memory loss, confusion, wandering behavior, sundowning, irritability & agitation) stage 3 is Ambulatory Dementia (loss of reasoning ability, increasing loss of expressive language, loss of ability to perform ADLs, more withdrawn) Stage is end stage (impaired or absent cognitive, communication, and/or motor skills, bowel and bladder incontinence, inability to recognize family members or self in mirror) |
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|
Term
| How is it best to communicate with an Alzheimer's Patient? |
|
Definition
| reincforce orientation to time, place & person, establish eye contact and use short, simple sentences when speaking to the client, encourage reminiscence about happy times, talk about familiar things, break instructions & activities into SHORT FRAMES when instructing the client. |
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Term
| How is safety insured in Alzheimer's Patients? |
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Definition
| client should wear an ID bracelet, lower bed, remove scatter rugs to prevent falls, provide glasses & hearing devices, use monitors and bed alarm devices as needed. |
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Term
| A client with delirium caused by a severe UTI would likely have: |
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Definition
| disorientation to time, place & person. wandering attention. perceptual disturbances. change in LOC. |
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Term
| The intervention appropriate for the nurse to use with a delirium/dementia patient is: |
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Definition
| reorient the client to the nurse with each contact |
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|
Term
| What causes reversible dementia? |
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Definition
| creutzfeldt-jakob disease, medication reaction |
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Term
|
Definition
| slow the progression of Alzheimer's temporarily |
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Term
| A client with delirium is attempting to remove the IV tubing from his arm, saying to the nurse, "Get off me! Go away!" The licent is experiencing which of the following? |
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Definition
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Term
| What is an imp intervention in helping a client with early-stage dementia complete activities of daily living? |
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Definition
| Allow enough time for the client to complete ADLs as independently as possible |
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Term
| What client with late-stage moderate dementia has been admitted to a long-term care facility. Which of the following nursing interventions will help the client to maintain optimal cognitive function? |
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Definition
| discuss pictures of children and grandchildren with the client. |
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Term
| Describe clinical manifestations of Personality Disorders, with a special focus on Borderline Personality Disorder. |
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Definition
| the pt typically becomes INFLEXIBLE, MALADAPTIVE and this starts to interfere how the person functions in society or causes the person emotional distress. Most will experience significant impairment in fulfilling family, academic, employment, and other functional roles. |
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Term
| The personality behaviors that seem 'ODD' or 'eccentric' include... |
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Definition
| paranoid, schizoid and schizotypal personality disorders. |
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|
Term
| the personality disorders that appear dramatic, emotional or erratic includes.. |
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Definition
| antisocial, borderline, histrionic, and narcissistic personality disorders. |
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|
Term
| the personality disoders that appear anxious or fearful are.. |
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Definition
| avoidant, dependent, and obsessive compulsive disorders |
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|
Term
| What knowledge & methods should nurses have when working with "personality disorder patients" |
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Definition
| these pt's do not typically think they have a problem and that their maladaptive behaviors are not dysfunctional. as a nurse it is your responsibility to identify these behaviors adn set goals to improve these dysfunctional behaviors. adjusting these behaviors will take a long time & IT IS IMP THAT THE NURSE NOT GET FRUSTRATED WITH THE PATIENT. Be aware of the patient trying to SPLIT THE STAFF WHEN IT COMES TO DETERMINING A TREATMENT PLAN. |
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|
Term
| what are the risk factors and morbidity statistics for Personality disorders? |
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Definition
| Personality disorders make up 10-13% of the population. 45% of these people have another personality disorder. those that are likely to develop personality disorders, have had relationship problems with parents. 50% of these patient have reported childhood sexual abuse, physical or verbal abuse or parental alcoholism. |
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Term
| What are the imp things for nurses to promote in children & their character development? |
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Definition
| it's important to include school and involvement in a religious community. Talk about parent/peer disapproval of anti-social behavior, and involvement in a religious community. Children that have these protective factors set in place are less likely to develop anti-social behaviors as an adult. |
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|
Term
| What are some traits involved in "personality disorders"? |
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Definition
| inflexible & maladaptive personality traits, enduring patterns of behavior, this behavior deviates from cultural expectations. |
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|
Term
| Personality disorders have problems with their cognition, explain... |
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Definition
| they have inaccurate perceptions of self, others & events. |
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Term
| Personality disorders have problems with inappropriate affect, explain... |
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Definition
| they'll be inappropriate, labile & intense |
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|
Term
| Personality disorder patients have inappropriate interpersonal behaviors & also impulse control... explain that. |
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Definition
| impulses are expressed at inappropriate times or places & with a lack of control. |
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|
Term
| Is therapy for personality disorders short or long term? |
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Definition
| it's LONG therapy. CHANGE IS MORE DIFFICULT THEN WITH OTHER DISORDERS. |
|
|
Term
| do meds help change their personality? |
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Definition
| NO, MEDICATION DOES NOT ALTER PERSONALITY |
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|
Term
| Diseases in cluster A, that are ECCENTRIC are: |
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Definition
| Paranoid, Schizotypal, & Schizoid |
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|
Term
| Diseases in cluster B, that are ERRATIC are: |
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Definition
| Borderline, Histrionic, Narcissistic & Antisocial |
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|
Term
| Diseases in Cluster C, that are FEARFUL are: |
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Definition
| avoidanct, dependent, obsessive-compulsive & passive aggressive |
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|
Term
| ____________ personality disorder is the one that is more freuently diagnosed. |
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Definition
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Term
| What is the difference between the mini-mental status exam & the actual mental status exam? |
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Definition
| The mental status exam looks at (judgement, insight, memory & intellect) & the mini mental status exam (includes orientation, registration, attention, memory, language) |
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|
Term
| some things that hapen in borderline personality disorder are: |
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Definition
| depression, self-destructive behaviors, broken relationships, poor work history, alienation from family, friends & coworkers. |
|
|
Term
| how much of the clinical population is diagnosed with borderline personality disorder? |
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Definition
| 11-70% - A lot! It's the most frequently diagnosed. There is about 1-2% of the general population with borderline personality disorders as well. |
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|
Term
| BPD feel how about abandonment? |
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Definition
| they have frantic efforts to avoid real or imagined abandonement. |
|
|
Term
| the clinical manifestations of BPD are: |
|
Definition
| intense & changing instability, unstable self image, unstable interpersonal relationships, they have intense idealization & devaluation. |
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Term
| How might BPD patients act? |
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Definition
| chronic emptiness, lots of impulsive actions (sex, money, driving, eating, drugs), BPD people have intense anger, suicidal behaviors (gestures, threats), self-mutilation. |
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Term
| What are some defenses that BPD patients use? |
|
Definition
| Splitting & Primitive Dissociation (split into "good" person vs "bad" person. Will split the staff against eachother. They may split rapidly towards one person - called projective identification. |
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|
Term
| What is Projective identification? |
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Definition
| projecting unacceptable impulses onto others. Watches the other person managing the impulses. |
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Term
| Does BPD usually occur as a lone disorder? |
|
Definition
| No, BPD very often has comorbidity. Other common problems of BPD pt's are: mood disorders, substance abuse, eating disorders, dissociative disorders, anxiety disorders. |
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|
Term
| What kind of therapy can be done for BPD? |
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Definition
| Teach about the disorder & have the patient participate |
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|
Term
| What are treatment goals for BPD? |
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Definition
| collecting data on own behavior & targeting behaviors for change |
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Term
| The Nursing Care plan for BPD is to establish a ____________ relationship. What else? |
|
Definition
| trusting. Provide a model for healthy relationships. Address abadonement & intimacy fears. Be very clear about relationship strength & amt of time to meet. Establish clear boundaries & limitations. It is important to SAY THE OBVIOUS & do NOT give personal information! |
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|
Term
| How should a nurse act towards a BPD patient? (direct or use countertransference?) |
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Definition
| BE DIRECT WITH BPD! Do NOT use countertransferance. |
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|
Term
| How should a nurse react to the idealization & devaluation that occurs with BPD? |
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Definition
| a nurse should remain neutral to idealization & devaluation. |
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|
Term
| It is imp for nursing care to set _________ on self-destructive behaviors of BPD pt's. |
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Definition
|
|
Term
| how can a nurse manage the dissociation that happens w/ BPD? |
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Definition
| explore other ways to handle the anxiety |
|
|
Term
| how can the staff help manage the environment for BPD? |
|
Definition
| consisteny in rules + structure, identify client induced staff conflict, assign ONE staff member as the contact person. |
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|
Term
| Skill that need development in BPD are: |
|
Definition
| emotional regulation, tolerance of stress, interpersonal, self-management, mindfulness (focusing). Cognitive interventions that challenge dysfunctional thinking. Analyze events that trigger strong feelings, identify triggers, look at other perspectives. examine the other side of the situation, identify opposing feelings the client has had toward a person. |
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|
Term
| __________________ personality disorders are the ones that engage in behavior against social laws, lack remorse, have no empathy for victims and most are in prisons. |
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Definition
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Term
| What nursing care can be done for Antisocial Personality Disorders? |
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Definition
| Assess for Aggression & Impulsivity. USE GROUP THERAPY. Prevent Manipulation, set limits. Seen in med/surg nursing & alcohol/drug areas. |
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|
Term
| _____________ personality disorder is one of the MOST frequent in MH clinics. |
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Definition
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|
Term
| What nursing care can be done for Dependent personality disorder? |
|
Definition
| help client recognize the dependent pattern, motivate them to change, teach living skills. |
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|
Term
| SO, you start thinking everyone you know has BPD. What's up? |
|
Definition
| EVERYONE has these traits to a certain extent. Especially teenager. These traits must be long-standing (lasting years) and be persistent. And they must be INTENSE. |
|
|
Term
| most people who have BPD have other concerns.. such as: |
|
Definition
| depression, eating disorders, substance abuse, even multiple personality disorder or ADD. It is difficult to isolate what is BPD and what might be something else. Do not diagnose yourself or others, talk to a profession |
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|
Term
| BPD patients often have a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization & devaluation. This is called "___________." |
|
Definition
|
|
Term
| BPD patients have frantic efforts to avoid real or imagined ____________. |
|
Definition
|
|
Term
| BPD is a pervasive pattern of: |
|
Definition
| instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in various contexts. Includes frantic efforts to avoid abandonement. Unstable & intense relationships that vary between idealization & devaluation (Splitting). |
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|
Term
| A borderline personality patient is like a child emotionally and at one particular moment sees one as ________ or _________. |
|
Definition
|
|
Term
| Personality Disorders are: |
|
Definition
| INFLEXIBLE, MALADAPTIVE & have ENDURING PATTERNS OF BEHAVIOR. This behavior deviates from cultural expectations. |
|
|
Term
| Are personality disorders easy or difficult to treat? |
|
Definition
|
|
Term
| Why does a BPD patient use splitting? |
|
Definition
| it is a PRIMITIVE DISSOCIATION. That splits into "good" person vs "bad" person. It splits the staff against one another. May split rapidly toward one person (projective identification). |
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|
Term
| When a BPD pt projects unacceptable impulses onto others & watches the other person manage the umpulses, this is called __________ ___________. |
|
Definition
| projective identification |
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|
Term
| Nursing care for BPD patients involves first establishing a |
|
Definition
| trusting relationship (provide a model for healthy relationships & address abandonement + intimacy fears) |
|
|
Term
| What kind of nursing care, in terms of commuication, is best for BPD patients? |
|
Definition
| Be clear about relationship length & amt of time to meet. Establish clear boundaries & limitations. Say the obvious & do NOT give personal info. Avoid countertransferance responses. Remain neutral to idealization & devaluation. |
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|
Term
| How can a nurse promote behavior change in BPD patients? |
|
Definition
| reinforce health behaviors, ignore minor negative behaviors, confront grossly inappropriate, disrespectful behavior. |
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|
Term
| Skills to develop in BPD patients are: |
|
Definition
| Emotional regulation, Tolerance of stress, interpersonal, self-management, mindfulness (focusing) |
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|
Term
| Cognitive Interventions that will help a BPD dysfunctional thinking are: |
|
Definition
| analyze events that trigger strong feelings identify triggers, looks at other perspectives, examine the other side of a situation, identify opposing feelings a client has had toward a person. |
|
|
Term
| self injurious behavior is: |
|
Definition
| deliberate, repetitive, impulsive, non-lethal harming of one's body without any intention to die as a result of the behavior. |
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|
Term
| Incidence & onset of self-injury is occuring: |
|
Definition
| earlier in the childhood and adolescent years. |
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|
Term
|
Definition
| cutting, scratching, picking scabs/interfering with wound healing, burning, punching self or objects, bruising or breaking bones, some forms of hair pulling,inserting objects into body openings, infecting oneself |
|
|
Term
| who is more likely to use self injury, males or females? |
|
Definition
| females are 3 times as likely, it is in the 15-24 year-old age group |
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|
Term
| Onset is usually at ________ for self-injury. The ones that seek treatment often have what background? |
|
Definition
| puberty. middle to upper class, average to high intelligence, low-self esteem. |
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|
Term
| Are self-injury patients borderline personality disorder patients or bipolar? |
|
Definition
|
|
Term
| Risk Factors that lead to self-injury are: |
|
Definition
| childhood physical or sexual abuse, violence happening at home, stormy parental relationships or broken homes, loss of parent through death or divorce, lack of emotional warmth (neglected), lack of validation during childhood, parental depression or alcoholism, confinement in residential institution, drug use. |
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|
Term
| What method is used for self-injury? |
|
Definition
| Many use multiple methods (cutting, scratching arms or legs is common. also, abd, head, chest, genitals) |
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|
Term
| Do they fess up to self-injury often? |
|
Definition
| no, the self-injurers may attempt to conceal the resultant scarring with clothing or say, maybe "the cat scratched me." |
|
|
Term
| Why do they self-injure themselves? |
|
Definition
| To feel concrete pain when psychic pain is too overwhelming, to reduce the numbness & promote sense of being real, to keep traumatic memories out of consciousness, affect modulation, discharge of anger, anxiety, despair & expression of disappointment. To gain a sense of control. To punish themselves b/c they perceive themselves as being bad. To enhance their self-esteem. |
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|
Term
| Many youth that self-injure do not seek treatment because: |
|
Definition
| they have intensely private & shameful feelings associated with the self-injury that prevents them from seeking treatment. EMBARRASSMENT & SHAME. |
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|
Term
| What causes patients to self-injure? |
|
Definition
| There is biological, psychological & sociological components. |
|
|
Term
| Biological reasons to self-injure are: |
|
Definition
| neurotransmitters are chemicals used to transmit messages in the brain. Neurotransmitters linked to self-injurious behavior are: Serotonin, Dopamine & Endorphins. |
|
|
Term
| Psychological reasons to self-injure are: |
|
Definition
| the ability to regulate emotions. (the hyperstress leads to feeling overwhelmed, unable to cope. Then there is dissociation that leads to numbness, feeling lost, alone, disconnected. This triggers self-injury that leads to feeling relieved & in control and calm. |
|
|
Term
| The sociological reason to self injure is: |
|
Definition
| has an element of BORDERLINE PERSONALITY. There is an inability to distract themselves from their emotional experiences, and self-injury is as an attempt to modulate or cope with strong emotions. |
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|
Term
| It is likely a combination of all 3 that lead to self-injury. |
|
Definition
| BIOLOGICAL (neurotransmitters), PSYCHOLOGICAL (hyperstress or dissociation) and SOCIOLOGICAL (borderline personality disorder). |
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|
Term
| Some good nursing questions for self-injury are: |
|
Definition
| open-ended! As what the cuts are from, ask them to tell you more about it, ask if it has ever happened before, is there a pattern to the incidents, what were they thinking or feeling when this happened and how they feel afterwards? |
|
|
Term
| What is a nursing diagnosis for self-injury? |
|
Definition
| 1. Self-mutilation (harm) r/t inability to express tension verbally & low self-esteem as evidenced by the cut/scratches on body 2. Risk for infection 3. Ineffective coping |
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|
Term
| The planning & interventions involved with self injury patients are: |
|
Definition
| PT WILL REPORT ANY THOUGHTS/URGES OF SELF HAMR TO THE STAFF BEFORE ACTING ON THEM. (Do a contract for safety, every 15 minute checks, deliberate avoidance of objects which could be used to self-injure (for ex/ paperclips, staples, erasers, sharp objects), the patient will identify 5 positive coping skills. |
|
|
Term
| What 2 imp factors contribute to the cessation of self-injury? |
|
Definition
| 1. developing an ability to identify and express feelings verbally 2. learning to USE BEHAVIORAL ALTERNATIVES to self-injury |
|
|
Term
| The outcome needed for self-injury patients is: |
|
Definition
| pt will have no thoughts/urges or acts to self-harm for 48 hrs prior to discharge |
|
|
Term
| What meds help self-injury patients? |
|
Definition
| depends on the underlying disorder, SSRI to address serotonin & depression. If it's bipolar or borderline. |
|
|
Term
| Key points to a personality disorder, are it is: |
|
Definition
| deviates from ones culture, it is pervasive, maladaptive & inflexible. It has an onset in adolescence or early childhood. It is stable over time & it leads to distress & impairment. |
|
|
Term
| All personality disorders: |
|
Definition
| have inflexibility/maladaptive responses to stress, disability in social and professional relationships, tendency to provoke interpersonal conflict and have the capacity to cause irritation or distress in others. |
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